Brooke Mahdavi, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN015346 Issued in GA

Practice address

955 Memorial Dr SE Ste 530
Atlanta, GA 30316-1566

Phone

(770) 800-5802

NPI assigned

Jun 12, 2019

Last updated

Mar 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 15, 2025 through Jan 15, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678579200000",
    "number": "1184283111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 CHESTER AVE SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303161201",
            "telephone_number": "239-940-0867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 MEMORIAL DR SE STE 530",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303161566",
            "telephone_number": "770-800-5802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Carnegie Pl Ste 102",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302143905",
            "country_code": "US",
            "telephone_number": "239-940-0867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHDAVI",
        "first_name": "BROOKE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-12",
        "last_updated": "2023-03-12",
        "certification_date": "2023-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "DN015346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Clark Mahan, LPC
• Anna Mahany
• Pratistha Maharjan
• Veronica Mahathre, LPC
• Zade Feras Mahayni
• Tiffani Maheia, PA-C
• Anne Maher, CPNP
• Kelsey Ann Maher, PA-C
• Kevin O Maher, M.D.
• Nabihah Mahmood, MD

• Orthodontics and Dentofacial Orthopedics Dentistry in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.